Objective To investigate the advantages and indications of combined laparoscopic surgery(CLS). Method 488 casesof laparoscopic procedures were given from May 1992 to February 2002.Among them 21 were CLS.Laparoscopic common bile duct exploration (LCBDE)+Laparoscopic cholecystectomy(LC)(7);Laparoscopic fenestration of liver syst+LC(4),LC+Laparoscopic appendectomy(4);LC+hand-assisted laparoscopic splenectomy(2);laparoscopic cystectomy for pancreatic pseudocyst+LC (1);LCBD+LC+Laparoscopic fenestration of right renal cyst(1)and LC+laparoscopic partial hepatectomy for small liver cancer(1). Results The combined procedures were succesful in all the 21 cases with no complications. Conclusions CLS has expanded the field of laparoscopy and advantages of minimally invasive nature and indications should be strictly choosen for the procedure.

Objective　 To investigate the indication and timing of surgery for acute necrotizing pancreatitis.　 Methods　 82 cases of acute necrotizing pancreatitis were analyzed retrospectively. 10 cases were treated non-operatively. Early operation was performed on 44 cases, while 28 cases underwent surgery on late stage.　 Results　 The overall morbidity and mortality was 24% and 18%, respectively. All 10 patients in the non-operative group were cured with a morbidity of 10%. The morbidity and mortality in the early operation group was 14% and 11%, respectively, compared with 46% and 36% of those receiving surgery on late stage（P＜0.01, P＜0.05）. Among those in late surgery group, patients not complicating infection had significant lower morbidity and mortality rate than those suffering from severe infection or organ dysfunction（P＜0.01, P＜0.05）.　 Conclusions　 Early operation is necessary for some severe cases.In patients with severe pancreatic necrosis surgery should be performed before severe infection occurs.

Objective To evaluate the place of kissing-stents technique in the management of aorto-iliac occlusive disease. Method Clinical data of 15 patients with aorto-iliac occlusive disease treated from Apr 2007 to Apr 2009 in our hospital were retrospectively analyzed. There were 9 males, and 6 females with a mean age of 66 years ( range 45-77 years). All 15 patients had significant symptoms of extremity ischemia. Claudication was complained in 11 (73% ) patients with an average distance of 88 meters. Four (27% ) patients had rest pain, gangrene of the toes was found in 2 patients ( 13% ). There were occlusive aorto- bilateral iliac artery with stenosis at superficial artery in 2 patients, occlusion at bilateral common iliac artery in 3 patients, occlusive disease at left common iliac artery with stenosis at bilateral superficial artery in 2 patients, occlusion at right common iliac artery in 8 patients, with stenosis or occlusion at superficial artery in 4 patients. In these 15 patients ABI was from 0.0 to 0.6, with an average of 0.36 ±0.3. Result Kissing-stents technique was successfully used in all 15 patients. 40 stents was released in bilateral common iliac arteries including 15 self-expanding stents and 25 balloon expandable stents. Residual stenosis was less than 30% and mean pressure gradient was 5 mm Hg. ABI increased from 0. 5 to 1.0 averaging at 0. 8 ±0. 2. The average hospitalization time was 7 days. Primary and secondary patency was 87% and 94% respectively as shown by a follow-up of 2 years. Conclusions Endovascular management of aorto-iliac occlusive disease by Kissing- stents technique is safe and effective and can raise the endovascular operation success rate and lower the complications.

OBJECTIVETo explore the relationship between continuous thrombocytopenia and sepsis in patients with severe burns.

METHODSClinical data of 148 severely burned patients admitted to our,two burn centers from January 2007 to December 2011 and conforming to the study criteria were retrospectively analyzed. All patients were divided into sepsis group (n =44) and non-sepsis group (n = 104) according to the presence or absence of sepsis within post burn day (PBD) 30. The data of age, gender, total burn area, full-thickness burn area, fluid infusion volume within post burn hour (PBH) 24, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, platelet count on PBD 1, acute physiology and chronic health evaluation (APACHE) II score on admission, the presence or absence of hypovolemic shock or inhalation injury on admission, the presence or absence of disseminated intravascular coagulation (DIC) within PBH 48, operation or no operation within PBD 3, thrombocytopenia duration within PBD 10, and mortality were statistically compared between two groups to screen the independent risk factors of sepsis. Data were processed with t test, chi-square test, single factor Logistic regression analysis, and multi-factor Logistic regression analysis.

RESULTSBetween two groups, there were statistically significant differences in total burn area, full-thickness burn area, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, APACHE II score on admission, presence or absence of hypovolem- ic shock on admission, presence or absence of inhalation injury on admission, presence or absence of DIC within PBH 48, and mortality (with t values from 2.433 to 4.082, χ2 values from 8. 818 to 31.528, P < 0.05 or P < 0.01). Furthermore, the duration of thrombocytopenia within PBD 10 in sepsis group was (5.2 ± 2.4) d, which was significantly longer than that in non-sepsis group [(2.9 ± 1.9) d, t =6. 189, P <0.01]. There were no statistically significant differences in the other indexes between two groups (with t values from 0.971 to 1. 250, χ2 values respectively 0. 054 and 1.529, P values above 0.05). Single factor and multi-factor Logistic regression analysis indicated that APACHE II score on admission and duration of thrombocytopenia within PBD 10 were closely related to occurrence of sepsis (with odds ratio respectively 1. 140 and 1.569, P values below 0.01).

CONCLUSIONSDuration of thrombocytopenia within PBD 10 is one of the risk factors for sepsis in severely burned patients, which can reflect pathophysiological changes in the body, thus providing predictive value for the occurrence of sepsis.

Aged ; Albumins ; Burn Units ; Burns ; blood ; complications ; diagnosis ; Humans ; Predictive Value of Tests ; Regression Analysis ; Retrospective Studies ; Sepsis ; blood ; etiology ; Shock ; blood ; etiology ; Thrombocytopenia

Objective To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods A multicenter, cross-sectional study was conducted. Totally, 112485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results In this study, the incidence of macrosomia was 7.46%(4563/611149). The macrosociam was positive related with maternal height, delivery week,pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly (P<0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2), respectively. Conclusion The reference range of GWG in China based on the incidence of macrosomia is established.

Objective To evaluate the clinical effects of autologous bone marrow transplantation(ABMT) in the treatment of patients with acute leukemia.Methods A retrospective study was accomplished on the ABMT in the treatment of 35 patients with acute leukemia from Oct 1999 to Oct 2004.The median age of the patients was 32.5(9～55) years.Of the 35 patients,26 cases were acute non-lymphocytic leukemia(ANLL) and 9 cases were acute lymphoblastic leukemia(ALL).The patients were pretreated with melphalan(140～180mg/m~2),cyclophosphamide(120mg/kg) and arabinosylcytosin(3g/m~2).Results All patients engrafted successfully.The median follow-up duration was 756(186～1950) days.The 3-year probabilities of disease-free-survival(DFS) for ANLL and ALL were(65.4%?8.9)% and(33.3?13.6)% respectively,and the probabilities of relapse were(30.6?9.2)% and(60.7?25.5)%,respectively.Conclusion To decrease relapse and increase DFS,patients with acute leukemia who have no chance for allogene haemopoietic stem cell transplantation are recommended for ABMT.

BACKGROUND:Studies have shown that there is a certain correlation between blood lipid levels and bone mineral density in postmenopausal women, but their correlation in men is an open question, which has been less reported. OBJECTIVE:To investigate the relationship between blood lipid levels and bone mineral density in Han and Uygur men with hypertension in Urumqi of Xinjiang Uygur Autonomous Region, as wel as correlation of blood lipid levels with osteoporosis and osteopenia and difference between ethnics. METHODS: A total of 193 male patients with hypertension were categorized into Uygur (n=73) and Han (n=120) groups. Each group was subdivided into osteoporosis or osteopenia group and non-osteoporosis group. Bone mineral density and blood lipid level were analyzed and compared between groups. The correlation between osteoporosis and risk factors was analyzed using logistic regression method. RESULTS AND CONCLUSION:In Uygur hypertension men with osteoporosis or osteopenia, total cholesterol level was positively correlated with the bone mineral density of the femoral neck (r=0.43,P=0.01) and Ward's area (r=0.42, P=0.01); while there were no relationships between blood lipid levels and bone mineral density in Han hypertension men. When a Logistic regression analysis was performed, only total cholesterol level was found to be associated with the presence of osteoporosis or osteopenia after adjustment for body mass index, age and ethnics (OR=1.48,P=0.03). The blood lipid level is associated with bone mineral density in Han and Uygur men with hypertension from Urumqi of Xinjiang Uygur Autonomous Region, which can affect the presence of osteoporosis.

OBJECTIVE: To identify morphological characteristics of Cyathula officinalis Kuan. and Cyathula capitata(Wall.) Moq.. METHODS: Based on tissue morphology features, C. officinalis Kuan. and Cyathula capitata (Wall.) Moq. were differentiated by using tissue sectioning, optical microscope, scanning electron microscopy and transmission electron microscopy technology. RESULTS: C. officinalis exhibited features, such as main roots, stems composed of four vascular bundles, relative rich trichomes, less green color, however, for C. capitata, hairy roots, stems composed of two vascular bundles and less trichomes were observed. Compared with low altitude condition, high-altitude condition may induce darker green color and formation of yellow spots and osmiophilic granules of leaves for C. capitata. CONCLUSION: It provides a scientific approach to differentiate these two closely related medicinal plants.

Objective To explore the incidence and distribution features of neonatal phenylketonuria(PKU) and congenital hypothyroidism(CH) in Lianyungang area.Methods The heel blood samples dried on filter paper was collected from newborns after 72 hours.As the screening indicators,PKU was detected through serum phenylalanine concentration(Phe) detection by Guthrie′s bacterial inhibition assay and CH was detected through serum thyroid stimulating hormone(TSH) levels detection by time-resolved fluorometry(TRFIA) or enzyme linked immunosorbent assay(ELISA).Results Sixty-four children with CH were diagnosed and the rate of CH was 1∶2423,41 patients were examined by thyroid gland nuclein kinescope picture,among which there were 23 patients whose thyroid glands were unusal.These patients lived in 45 towns(streets),which had no difference between men and women,city and country side.A couple of twins were screened for CH;15 cases of PKU was detected with an incidence of 1∶10 339.These patients′ parents were neither consanguineous marriage nor dominance hereditary family history.Their physical and mental development were similar to the same age children after interventive treatment.Conclusions The distribution of CH and PKU is diffuse in Lianyungang.Neonatal screening is the only valid means to find patients with CH and PKU.

Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Stents